A web-based telemedicine system for low-resource settings 13 years on: insights from referrers and specialists

Background: One way to tackle health inequalities in resource-poor settings is to establish links between doctors and health professionals there and specialists elsewhere using web-based telemedicine. One such system run by the Swinfen Charitable Trust has been in existence for 13 years which is an unusually long time for such systems.

Objective: We wanted to gain some insights into whether and how this system might be improved.

Methods: We carried out a survey by questionnaire of referrers and specialists over a six months period.

Results: During the study period, a total of 111 cases were referred from 35 different practitioners, of whom 24% were not doctors. Survey replies were received concerning 67 cases, a response rate of 61 per cent. Eighty-seven per cent of the responding referrers found the telemedicine advice useful, and 78% were able to follow the advice provided. As a result of the advice received, the diagnosis was changed in 22% of all cases and confirmed in a further 18 per cent. Patient management was changed in 33 per cent. There was no substantial difference between doctors and non-doctors. During the study period, the 111 cases were responded to by 148 specialists, from whom 108 replies to the questionnaire were received, a response rate of 73 per cent. About half of the specialists (47%) felt that their advice had improved the management of the patients. There were 62 cases where it was possible to match up the opinions of the referrer and the consultants about the value of a specific teleconsultation. In 34 cases (55%) the referrers and specialists agreed about the value. However, in 28 cases (45%) they did not: specialists markedly underestimated the value of a consultation compared to referrers. Both referrers and specialist were extremely positive about the system which appears to be working well. Minor changes such as a clearer referral template and an improved web interface for specialists may improve it.

Pull-out forces in shear connectors in composite beams with large web openings

Composite beams with large web openings are often used, and their design is controlled by Vierendeel bending at the four corners of each opening, which is assisted by local composite action with the floor slab. Development of this Vierendeel bending resistance may be limited by pull-out failure of the shear connectors. In this paper, a non-linear elasto-plastic finite element model of a composite beam with web openings was used to investigate this mode of pull-out failure. A test was performed on a typical composite slab in which the shear connectors were subject to pure tension and the failure load was 67 kN, which is approximately 70% of the longitudinal shear resistance. The results of the finite element model are compared against those obtained using the established design theory, that does not limit the vertical pull-out resistance of the shear connectors. It is shown that the local bending resistance due to composite action should be reduced when limited by pull-out of the shear connectors. A parametric study investigated the effect of openings of 600 to 1200 mm length. A simple model is developed to establish the Vierendeel bending resistance, when limited by pull-out of the shear connectors.

DiveRsity: An R package for the estimation and exploration of population genetics parameters and their associated errors

Summary: We present a new R package, diveRsity, for the calculation of various diversity statistics, including common diversity partitioning statistics (?, G) and population differentiation statistics (D, GST ', ? test for population heterogeneity), among others. The package calculates these estimators along with their respective bootstrapped confidence intervals for loci, sample population pairwise and global levels. Various plotting tools are also provided for a visual evaluation of estimated values, allowing users to critically assess the validity and significance of statistical tests from a biological perspective. diveRsity has a set of unique features, which facilitate the use of an informed framework for assessing the validity of the use of traditional F-statistics for the inference of demography, with reference to specific marker types, particularly focusing on highly polymorphic microsatellite loci. However, the package can be readily used for other co-dominant marker types (e.g. allozymes, SNPs). Detailed examples of usage and descriptions of package capabilities are provided. The examples demonstrate useful strategies for the exploration of data and interpretation of results generated by diveRsity. Additional online resources for the package are also described, including a GUI web app version intended for those with more limited experience using R for statistical analysis. © 2013 British Ecological Society.

Reflecting on Psycho-Social Domains in Social Work: Towards a Model of Enabling Others (Monograph Version with ISBN)

This monograph develops a model of reflexivity for social workers based on the work of Derek Layder. It examines psycho-biographical, interactional, institutional, cultural and economic factors and how they enable and constrain social work practice.

Food web indicators under the Marine Strategy Framework Directive: From complexity to simplicity?

The Marine Strategy Framework Directive (MSFD) requires that European Union Member States achieve "Good Environmental Status" (GES) in respect of 11 Descriptors of the marine environment by 2020. Of those, Descriptor 4, which focuses on marine food webs, is perhaps the most challenging to implement since the identification of simple indicators able to assess the health of highly dynamic and complex interactions is difficult. Here, we present the proposed food web criteria/indicators and analyse their theoretical background and applicability in order to highlight both the current knowledge gaps and the difficulties associated with the assessment of GES. We conclude that the existing suite of indicators gives variable focus to the three important food web properties: structure, functioning and dynamics, and more emphasis should be given to the latter two and the general principles that relate these three properties. The development of food web indicators should be directed towards more integrative and process-based indicators with an emphasis on their responsiveness to multiple anthropogenic pressures. (C) 2013 Elsevier Ltd. All rights reserved.

Web Psychosocial Surveys in Cancer Survivorship— A Methodological Note

The number of Internet surveys is increasing, and there is a need to examine critically their value in psychosocial cancer care research. This study explored the use of an online method of recruiting and surveying people affected by cancer. An online survey was designed to measure the health status and service needs of adult cancer survivors and caregivers. The online survey received 491 page visits; only 5% of visitors (13 survivors and 14 cancer caregivers) completed the online questionnaire. The average age of survivors and caregivers was 43 and 42 years, respectively. The majority of survivor and caregiver online respondents were female (23/27, 85%) and had been affected by cancer between 1 and 3 years previously (16/27, 59%). Our online research did not appear to be an effective method for recruiting and surveying the psychosocial health of cancer survivors. This study identified potential pitfalls and obstacles of online cancer care surveys particularly in relation to the age of cancer survivors, access to the Internet and the need to ensure surveys are easily and immediately accessible. Future Internet surveys should pay particular attention to the need to advertise and improve survey access via targeted and tailored techniques.

Web adoption by Irish credit unions: Performance implications

The purpose of this paper is to examine website adoption and its resultant effects on credit union performance in Ireland over the period 2002 to 2010. While there has been a steady increase in web adoption over the period a sizeable proportion (53%) of credit unions did not have a web-based facility in 2010. To gauge web functionality the researchers accessed all websites in 2010/2011 and it transpired that most sites were classified as informational with limited transactional options. Panel data techniques are then used to capture the dynamic nature of website diffusion and to investigate the effect of website adoption on cost and performance. The empirical analysis reveals that credit unions that have web-based functionality have a reduced spread between the loan and pay-out rate with this primarily caused by reduced loan rates. This reduced spread, although small, is found to both persist and increase over time.